慢性化脓性中耳炎耳道分泌物病原菌分析  

A Retrospective Analysis of Pathogenic Bacteria and Drug Sensitivity Test in Patients with Chronic Suppurative Otitis Media

作　　者：李新建[1] 翟性友 刘明波[1,2] LI Xin-jian;ZHAI Xing-you;LIU Ming-bo

机构地区：[1]解放军总医院海南医院耳鼻咽喉头颈外科,三亚572000 [2]解放军总医院耳鼻咽喉头颈外科,北京100853

出　　处：《中国听力语言康复科学杂志》2020年第3期169-171,共3页Chinese Scientific Journal of Hearing and Speech Rehabilitation

摘　　要：目的了解慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者耳道分泌物病原菌分布情况以及药敏试验数据,指导临床合理用药。方法通过检索中国期刊全文数据库、万方数据库及中国生物医学文献数据库近5年发表的有关CSOM病原菌培养及药敏试验的描述性文献,共筛选出18篇文献进入本研究。对文献中所有患者的分布地区、一般性资料、病原菌检出率、革兰阳性菌数量、革兰阴性菌数量、真菌数量以及其药物敏感试验数据进行分析。结果本文共研究CSOM患者3451耳,2863耳培养出病原菌,检出率为82.67%,共培养出病原菌3374株,其中革兰阳性(G+)菌1650株,占48.90%,革兰阴性(G-)菌1414株,占41.91%,真菌310株,占9.19%。其中革兰阳性菌检出前两位的细菌为金黄色葡萄球菌(800株,占23.71%)、凝固酶阴性葡萄球菌(coagulase negative staphylococci,CNS)(552株,占16.36%),革兰阴性菌检出前三位的细菌为铜绿假单胞菌(612株,占18.14%)、肺炎克雷伯杆菌(170株,占5.04%)、变形杆菌(166株,占4.92%)。金黄色葡萄球菌、凝固酶阴性葡萄球菌对左氧氟沙星、莫西沙星、苯唑西林、庆大霉素、万古霉素等敏感性较高,对青霉素G耐药性很高。铜绿假单胞菌、肺炎克雷伯杆菌及变形杆菌对左氧氟沙星、庆大霉素、头孢他啶、亚胺培南高度敏感,对头孢曲松敏感性较低。结论 CSOM患者病原菌主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、肺炎克雷伯杆菌及变形杆菌,真菌感染已不容忽视。根据药敏结果数据可得出经验性一线用药为哌拉西林、左氧氟沙星(成人)、苯唑西林,左氧氟沙星滴耳液也可做为局部用药。临床选择抗生素应以药敏结果为标准,在无相应条件时,可参考本研究结果选择。Objective To investigate the distribution of pathogenic bacteria in the ear canal secretions of chronic suppurative otitis media(CSOM) patients and the data of drug sensitivity test, so as to guide rational medication in clinic. Methods 18 research papers were selected for the study of CSOM pathogenic bacteria culture and drug sensitivity test published in the past 5 years by searching the full text database of Chinese Journal, Wanfang Database and Chinese Biomedical Literature Database.The distribution area, general data, detection rate of pathogenic bacteria, number of Gram-positive bacteria, number of Gram-negative bacteria, number of fungi and drug sensitivity test data of all patients in the literature were analyzed in detail. Results In this article, 3,451 ears of patients with CSOM were studied. The pathogens were found in 2,863 ears. The detection rate was 82.67%. A total of 3,374 beads of pathogenic bacteria were cultured. Among them, 1,650 beads of Gram-positive(G+) bacteria accounted for 48.90%, 1,414 beads of Gram-negative(G-) bacteria accounted for 41.91%, and 310 beads of fungi accounted for 9.19%. The top two bacteria detected by Gram-positive bacteria were Staphylococcus aureus(800 beads, 23.71%), and coagulase negative staphylococci(CNS)(552 beads, 16.36%). The top three bacteria detected by Gram-negative bacteria were Pseudomonas aeruginosa(612 beads, 18.14%), Klebsiella pneumoniae(170 beads, 5.04%) and Proteus mutans(166 beads, 4.92%). Staphylococcus aureus and coagulase negative staphylococci were highly sensitive to levofloxacin, moxifloxacin, oxacillin, gentamycin and vancomycin, and were highly resistant to penicillin G. Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus were highly sensitive to levofloxacin, gentamicin, ceftazidime and imipenem, but less sensitive to ceftriaxone. Conclusion The main pathogens of CSOM patients are Staphylococcus aureus, Coagulase negative staphylococcus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus. Fungal infection can not be ignored. A

关 键 词：慢性化脓性中耳炎 病原菌 药敏试验 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]